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Accepted for/Published in: JMIR Mental Health

Date Submitted: May 20, 2021
Open Peer Review Period: May 19, 2021 - Jul 14, 2021
Date Accepted: Jul 22, 2021
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review

Zurynski Y, Ellis LA, Tong HL, Laranjo L, Clay-Williams R, Testa L, Meulenbroeks I, Turton C, Sara G

Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review

JMIR Ment Health 2021;8(9):e30564

DOI: 10.2196/30564

PMID: 34491208

PMCID: 8456340

Implementation of electronic medical records in mental health settings: a scoping review

  • Yvonne Zurynski; 
  • Louise A Ellis; 
  • Huong Ly Tong; 
  • Liliana Laranjo; 
  • Robyn Clay-Williams; 
  • Luke Testa; 
  • Isabelle Meulenbroeks; 
  • Charmaine Turton; 
  • Grant Sara

ABSTRACT

Background:

The success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges, due to the personal, detailed, narrative, and exploratory nature of assessment, diagnosis, and treatment in this field. Understanding the determinants of successful implementation of EMRs is imperative to guide future design, implementation, and investment of EMRs in the mental health field.

Objective:

To explore evidence on effective EMR implementation for mental health settings, and to provide recommendations to support design, adoption, usability, and outcomes.

Methods:

Two scoping reviews of the peer-reviewed literature were conducted. The first reviewed primary research on clinician-facing EMRs implemented in mental health settings. The second was a review of reviews of clinician-facing EMRs implemented in all health settings. Three databases (Medline, EMBASE, and PsychINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used as an organising theory to support data extraction and synthesis. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.

Results:

Twenty-three studies were included: 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested adoption of EMRs is impacted by financial, technical, and organisational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on feasibility of EMRs was mixed; primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events while a review found improvements in care quality. Five papers (21.7%) provided information on implementation outcomes such as cost and fidelity, and none reported on penetration and sustainability of EMRs.

Conclusions:

The evidence underpinning acceptability and usefulness of EMRs to clinicians working in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-design of the software and tailoring to clinical needs and workflows to improve usability and acceptance. Furthermore, embedding evaluations of implementation processes and long-term impacts of implementing EMRs should become routine to address the current gaps in knowledge.


 Citation

Please cite as:

Zurynski Y, Ellis LA, Tong HL, Laranjo L, Clay-Williams R, Testa L, Meulenbroeks I, Turton C, Sara G

Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review

JMIR Ment Health 2021;8(9):e30564

DOI: 10.2196/30564

PMID: 34491208

PMCID: 8456340

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